Health and Human Services Secretary Kathleen Sebelius today announced the next steps for providers who are using electronic health record (EHR) technology and receiving incentive payments from Medicare and Medicaid. These proposed rules, from the Centers for Medicaid & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), will govern stage 2 of the Medicare and Medicaid Electronic Health Record Incentive Programs.

“We know that broader adoption of electronic health records can save our health care system money, save time for doctors and hospitals, and save lives,” said Secretary Sebelius. “We have seen great success and momentum as we’ve taken the first steps toward adoption of this critical technology. As we move into the next stage, we are encouraging even more providers to participate and support more coordinated, patient-centered care.”

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act of 2009, eligible health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt certified EHR technology and use it in a meaningful way. What is considered “meaningful use” is evolving in three stages:

Stage 1 (which began in 2011 and remains the starting point for all providers): “meaningful use” consists of transferring data to EHRs and being able to share information, including electronic copies and visit summaries for patients.

Stage 2 (to be implemented in 2014 under the proposed rule): “meaningful use” includes new standards such as online access for patients to their health information, and electronic health information exchange between providers.

Stage 3 (expected to be implemented in 2016): “meaningful use” includes demonstrating that the quality of health care has been improved.

CMS’ proposed rule specifies the stage 2 criteria that eligible providers must meet in order to qualify for Medicare and/or Medicaid EHR incentive payments. It also specifies Medicare payment adjustments that, beginning in 2015, providers will face if they fail to demonstrate meaningful use of certified EHR technology and fail to meet other program participation requirements. In a November 2011 “We Can’t Wait” announcement (http://www.hhs.gov/news/press/2011pres/11/20111130a.html), the Department outlined plans to provide an additional year for providers who attested to meaningful use in 2011. Under today’s proposed rule, stage 1 has been extended an additional year, allowing providers to attest to stage 2 in 2014, instead of in 2013. The proposed rule announced by ONC identifies standards and criteria for the certification of EHR technology, so eligible professionals and hospitals can be sure that the systems they adopt are capable of performing the required functions to demonstrate either stage of meaningful use that would be in effect starting in 2014.

“Through the Medicare and Medicaid EHR Incentive Programs, we’ve seen incredible progress as over 43,000 providers have received $3.1 billion to help make the transition to electronic health records,” said CMS Acting Administrator Marilyn Tavenner. “There is great momentum as the number of providers adopting this technology grows every month. Today’s announcement will help ensure broad participation and success of the program, as we move toward full adoption of this money-saving and life-saving technology.”

“The proposed rules for stage 2 for meaningful use and updated certification criteria largely reflect the recommendations from the Health IT Policy and Standards Committees, the federal advisory committees that operate through a transparent process with broad public input from all key stakeholders. Their recommendations emphasized the desire to increase health information exchange, increase patient and family engagement, and better align reporting requirements with other HHS programs,” said Farzad Mostashari, MD, ScM, National Coordinator for Health Information Technology. “The proposed rules announced today will continue down the path stage 1 established by focusing on value-added ways in which EHR systems can help providers deliver care which is more coordinated, safer, patient-centered, and efficient.”

The number of hospitals using EHRs has more than doubled in the last two years from 16 to 35 percent between 2009 and 2011. Eighty-five percent of hospitals now report that by 2015 they intend to take advantage of the incentive payments.

The Centers for Medicare and Medicaid Services has laid out the details for how it will raise the bar for healthcare providers to qualify for incentives with the release Feb. 23 of its proposed rule for Stage 2 of meaningful use of electronic health records.

Among its provisions, CMS will delay the start of Stage 2 until 2014 instead of 2013.

As expected, the next stage of meaningful use builds on the criteria of the first stage, including increasing the threshold for performance of existing measures and pushing providers to actually exchange information in various transactions to drive continuous quality improvement.

In Stage 2, CMS said it would keep the same core-menu structure for required measures. Physicians will meet 17 core objectives and three of five menu options. Hospitals will meet 16 core measures and two of four menu options.

Note: This link has a great summary of the proposed requirements for 2014.

The Centers for Medicare and Medicaid Services’ proposed rule for Stage 2 of the electronic health records meaningful use program does not mandate use of encryption, but it does emphasize increased consideration of encryption of data at rest in ambulatory and inpatient EHR systems.

Stage 1 meaningful use security requirements rely on HIPAA security rule provisions under federal code 45 CFR. Under HIPAA, encryption is an “addressable” specification, meaning a covered entity decides if it is a “reasonable and appropriate” technical security step to implement. The security rule enables an entity to adopt an alternative protective measure that achieves the same purpose if the alternative is reasonable and appropriate.

In the Stage 2 proposed rule, CMS specifically calls out the issue of encryption at rest and heightens the importance of analyzing the pros and cons of using the technology.

February 23, 2012 — Physicians will need to communicate with patients online to satisfy new and tougher federal rules for "meaningful use" of electronic health records (EHRs), earn 5-figure bonuses, and avoid a penalty down the line.

Under proposed regulations released today by the Centers for Medicare and Medicaid Services (CMS), physicians must receive "secure messages," an encrypted form of email, from more than 10% of patients seen. In addition, they must give patients timely electronic access to their healthcare information.

The new requirements will not take effect until 2014.

Last year, CMS began awarding bonuses under Medicare and Medicaid to physicians who meet an initial set of meaningful use requirements designed to improve the quality of care. There are currently 25 stage 1 objectives, 15 of which are mandatory and 10 elective. The mandatory objectives include electronically prescribing more than 40% of prescriptions and recording demographic information, such as date of birth, sex, and race, as structured data for more than 50% of patients seen. Physicians must satisfy any 5 of the 10 elective requirements.

In stage 2, the number of mandatory objectives increases to 17, with physicians able to choose 3 of 5 elective objectives. Almost all of the stage 1 mandatory and elective objectives graduated to stage 2, with a few of them combined for simplicity's sake.

The stage 2 requirements raise the bar for digital doctoring that the federal government will reward. For starters, stage 2 thresholds for carryovers from stage 1 are more demanding. Meaningful users, for example, must e-prescribe more than 65% of their prescriptions (increased from 40%), and the threshold for recording demographic data goes up to more than 80% of patients.

Clinical quality measures are a major focus in both the proposals for Meaningful Use stage 2 and the 2014 EHR certification criteria, government officials told attendees at the Las Vegas meeting of the Healthcare Information and Management Systems Society (HIMSS) this week. But this critical element of Meaningful Use remains in flux. The just published Notice of Proposed Rule Making[1] (NPRM) asks commenters to provide guidance in this area, the officials said.

In general, the proposed rules require eligible professionals (EP) to report on 12 clinical quality measures (CQMs) in Stage 2, twice the number in Stage 1. Hospitals must report on 24 CQMs, up from 15 in Stage 1. They must choose one or more of the CQMs from each of the domains adopted by CMS from the National Quality Strategy.

-----

The good news is that the reaction to what is planned seems pretty positive:

Attendees at the Healthcare Information and Management Systems Society's annual conference in Las Vegas greeted the announcement today of the proposed rules for Stage 2 Meaningful Use[1] and electronic health record certification with applause. But the actual implementation of these requirements--those that are retained in the final rule, at least--will certainly pose some major challenges to both providers and EHR vendors.

Stage 2 is "hard work, but we can get there, even with ICD-10 and other regulatory requirements," Neal Ganguly, vice president and CIO of CentraState Healthcare System[2] in Freehold, N.J., told FierceHealthIT. CentraState has already attested to Stage 1 Meaningful Use and received its 2011 payment, he noted.

The Stage 2 Meaningful Use rules and EHR certification standards largely reflect the recommendations made last year by the Health IT Policy Committee and the Health IT Standards Committee, National Coordinator for Health IT Farzad Mostashari told the overflow crowd.

-----

Comment:

This is important ground breaking work I believe, where financial incentives are progressively being linked to using e-Health IT to make a serious difference to patient outcomes.

Hardly what is being done with the PCEHR I have to say!

There were a good number of Australians at HIMSS - they know about all this material so why are our heads so firmly placed looking in the rear mirror?